18-B5 - HSA FSA HRA Questionnaire.xlsx
XLSX spreadsheet 138 KB Posted
- Attached to
- Ancillary Insurance Benefits
- Solicitation number
- RFP 2026-018
- Issued by
- Johnson County, Texas
About this file
This file is a Request for Proposal (RFP) questionnaire prepared by Lockton Companies on behalf of the City of Burleson, Texas, for the administration of Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Health Reimbursement Arrangements (HRA), with an effective date of January 1, 2027. The document solicits comprehensive information from prospective vendors regarding their qualifications, service capabilities, and pricing for administering these ancillary benefit programs. The questionnaire addresses implementation timelines, customer service support, claims processing procedures, debit card administration, member portal functionality, employer portal capabilities, reporting systems, and data integration with the City's existing HRIS/Payroll vendors (BenTek and Tyler/Munis). Bidders are required to provide detailed responses on account management, staff dedication, bilingual support capabilities, and participation in open enrollment and health fair events.
Pricing proposals are requested for HSA administration at $1.50 PEPM (per employee per month) with an annual cost of $3,600 for the current 200 HSA participants, FSA administration at $3.95 PEPM with an annual cost of $1,327 for 28 current participants, and HRA administration at $3.50 PEPM with an annual cost of $126 for three participants. The questionnaire requires vendors to guarantee rates for a minimum of five years and to provide performance guarantees related to implementation, card delivery, account management, claims processing, customer service, and reporting. Vendors must also clarify whether the incumbent administrator (identified as FloresHR for FSA and HRA services) will cooperate with electronic data transfer during the transition phase and whether they can integrate with the City's existing banking and payroll systems. The document includes optional services such as enrollment materials, Section 125 plan documents, bilingual support, discrimination testing, direct deposit capability, and automatic claims adjudication, with specifications regarding which services are included in standard fees versus available at additional cost.
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Text version
Front Cover
Request for Proposal - HSA, FSA & HRA Administration
City of Burleson
| Prepared by: |
| Lockton Companies |
| Effective Date |
| 1/1/27 |
| 6900 Dallas Parkway, Ste 450 |
| Plano, TX 75024 |
| Telephone |
| www.lockton.com |
Vendor Information
| Bidder Information |
| Vendor Name |
| Vendor Contact Name |
| Vendor Contact Email |
| Vendor Contact Phone Number |
&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P
HSA - Financial Summary
| Health Savings Account Financial Summary | |||
| HSA Bank | Bidder Name | ||
| City Contribution | $850/individual coverage | ||
| $1,700/family coverage | $850/individual coverage |
$1,700/family coverage
| Current Participation | ||
| • | H.S.A. | 200 |
| TOTAL | 200 | |
| Initial Set-Up Fees (indicate if annual or one-time) | $0 | |
| Monthly Fees | ||
| HSA Administration Fee PEPM | $1.50 | |
| HSA Administration Fee PEPM WAIVERS | Fee waived for each employee account balance over $3000 | |
| Debit Card Fee (indicate cost of replacement cards) | Included | |
| Monthly Minimum Fee | N/A | |
| First Year Annual Cost | $3,600 | |
| Optional Services and Fees (please indicate whether services are included in above fees or additional cost. If additional cost, please indicate cost) | ||
| • | Enrollment Materials | Included |
| • | Enrollment Meetings | Additional fee |
| • | Materials & Meetings for Bi-lingual Populations | Included |
| • | Section 125 Plan Document | Included |
| • | Summary Plan Description | Included |
| • | Printed statement fee | $1.50 |
| Describe any other costs that will be charged to this client | No Fee | |
| Rate Guarantee (months) | 12 | |
| Notes |
K 11
| Carrier Opts | 4 | |
| Plan | Tier | X Rows |
| TRUE | 4 | FALSE |
| TRUE | 4 | FALSE |
| TRUE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| Ben Grid | FALSE | |
| TRUE | FALSE | FALSE |
| TRUE | FALSE | FALSE |
| TRUE | TRUE | FALSE |
| TRUE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
FSA - Financial Summary
| Flexible Spending Account Financial Summary | |||
| FloresHR | Bidder Name | ||
| Current | Proposed | ||
| Current Participation | |||
| • | Healthcare FSA | 26 | |
| • | Dependent FSA | 2 | |
| TOTAL | 28 | ||
| Initial Set-Up Fees (indicate if annual or one-time) | N/A | ||
| Monthly Fees | $0.00 | ||
| Medical FSA Administration Fee PEPM | $3.95 | ||
| Dependent Care FSA Administration Fee PEPM | $3.95 | ||
| Debit Card Fee (indicate cost of replacement cards) | No Charge | ||
| Monthly Minimum Fee | $100 | ||
| First Year Annual Cost | $1,327 | ||
| Optional Services and Fees (please indicate whether services are included in above fees or additional cost. If additional cost, please indicate cost) | |||
| • | Enrollment Materials | Included | |
| • | Enrollment Meetings | Included | |
| • | Materials & Meetings for Bi-lingual Populations | Included | |
| • | Section 125 Plan Document | Included | |
| • | Summary Plan Description | Included | |
| • | Direct Deposit Capability | Included | |
| • | Automatic Claim Adjudication | Included | |
| • | Discrimination Testing Annually | Included | |
| Describe any other costs that will be charged to this client | |||
| • | Annual Renewal | No Fee | |
| Rate Guarantee (months) | 60 | ||
| Notes |
K 11
| Carrier Opts | 4 | |
| Plan | Tier | X Rows |
| TRUE | 4 | FALSE |
| TRUE | 4 | FALSE |
| TRUE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| Ben Grid | FALSE | |
| TRUE | FALSE | FALSE |
| TRUE | FALSE | FALSE |
| TRUE | TRUE | FALSE |
| TRUE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
&G &P
HRA - Financial Summary
| HRA Financial Summary | |||
| FloresHR | Bidder Name | ||
| Current Participation | |||
| • | Health Reimbursement Account | 3 | |
| TOTAL | 3 | ||
| Initial Set-Up Fees (indicate if annual or one-time) | $0 | ||
| Monthly Fees | |||
| HRA Administration Fee PEPM | $3.50 | ||
| Debit Card Fee (indicate cost of replacement cards) | Included | ||
| Monthly Minimum Fee | $100 | ||
| First Year Annual Cost | $126 | ||
| Optional Services and Fees (please indicate whether services are included in above fees or additional cost. If additional cost, please indicate cost) | |||
| • | Enrollment Materials | Included | |
| • | Enrollment Meetings | Included | |
| • | Materials & Meetings for Bi-lingual Populations | Included | |
| • | Section 125 Plan Document | Included | |
| • | Summary Plan Description | Included | |
| • | Direct Deposit Capability | Included | |
| • | Automatic Claim Adjudication | Included | |
| • | Discrimination Testing Annually | Included | |
| Describe any other costs that will be charged to this client | No Fee | ||
| Rate Guarantee (months) | 60 | ||
| Notes |
K 11
| Carrier Opts | 4 | |
| Plan | Tier | X Rows |
| TRUE | 4 | FALSE |
| TRUE | 4 | FALSE |
| TRUE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| FALSE | 4 | FALSE |
| Ben Grid | FALSE | |
| TRUE | FALSE | FALSE |
| TRUE | FALSE | FALSE |
| TRUE | TRUE | FALSE |
| TRUE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
| FALSE | FALSE | FALSE |
Questionnaire HSA, FSA and HRA Questionnaire
| Organization | [Insert Administrator Name] | ||
| v | How long has your business been in existence? | ||
| v | How long has your business been administering HSA, FSA and HRA accounts? | Please Select | |
| v | Provide the location of your business. | ||
| v | For how many clients do you provide HSA, FSA and HRA administration services? | ||
| v | What is the average size of your clients? What is the largest? The smallest? | ||
| v | Provide three current client references similar in size and industry. Include contact name, title and phone number. | ||
| Customer Service/Member Service | |||
| v | Will you provide a dedicated account manager for this client? | Please Select | |
| v | Will member and client calls be handled by this individual or by your general customer service department? | ||
| v | Describe customer service support available to participants (phone, chat, email, secure messaging) and hours of operation? | ||
| v | What languages does your customer support team currently offer for participant assistance across all service channels (phone, chat, email, and secure messaging)? | ||
| v | How are claims accepted? | ||
| v | What is your claims turnaround time? | ||
| v | How do you assure turnaround times are meeting your commitment? | ||
| v | Do you have an arrangement with the health plan claims administrator (UHC) that will facilitate automatic claims adjudication? | Please Select | |
| v | Is claims verification (receipts) required? | Please Select | |
| Describe the member website capabilities (what can members do after logging in). | |||
| v | Do you offer a mobile app? | Please Select | |
| v | Can participants submit claims and view balance information via the app? | Please Select | |
| v | Describe the member mobile app capabilities. | ||
| v | How quickly is transaction information updated on member accounts in the website/mobile app (how current is the data) | ||
| v | What types of standard reports do you provide the client? | ||
| v | Can H.S.A. account administration fees be covered by the employee or the employer? | Please Select | |
| v | How often do you allow contribution changes and are there any restrictions during the year for changes? | ||
| v | Describe your employer portal functionality. | ||
| v | How often is data refreshed in the employer portal? | ||
| v | What implementation and training support is provided for employer portal users? | ||
| v | What tools or resources do you provide to help participants understand their account- eligible expenses, and long-term investing? | ||
| Implementation | |||
| v | What is the lead time for implementation? (Please provide a tentative timeline.) | ||
| v | What information do you require in order to begin the implementation process? | ||
| v | Are you willing to work with the incumbent administrator to transfer data electronically? | Please Select | |
| v | Do you have integration capability with the City's HRIS/Payroll vendor, BenTek and Tyler/Munis? | Please Select | |
| v | Do you allow automatic enrollment. If yes, describe the process. | ||
| Financial Information | |||
| v | Please describe the banking options for bill payment that are available to City of Burleson. | ||
| v | Can City of Burleson use its own bank? | ||
| v | Is a minimum deposit required? | Please Select | |
| v | Please describe the funding options for participant accounts. | ||
| v | When do you request funds and for what claims period? | ||
| v | Do you utilize an imaging system to record claims documents? | Please Select | |
| v | What is the turnaround on completed claim forms? | ||
| v | How are incomplete or denied claims communicated? | ||
| v | Please confirm if the rates/costs above are guaranteed for a minimum of five years. | ||
| v | Please indicate which of the following services you provide and include in your pricing: (If the service is optional at an additional cost, please note cost.) | ||
| v | Plan Document | ||
| v | Summary Plan Description | ||
| v | Toll-free call center | ||
| v | Daily claims adjudication | ||
| v | Non-discrimination testing | ||
| v | Participation in onsite events - open enrollment, training, health fairs (indicate how many included per year) | ||
| v | Participation in virtual events - training |
(indicate how many included per year)
| v | Other (please list) | |
| Debit Card | ||
| v | Is a debit card an option, or is it mandatory? | |
| v | Is your debit card outsourced, or is it a wholly-owned card? | |
| v | How do you ensure the amounts debited are for "qualified benefits" under Code section 125? | |
| v | Describe your process for working with health care providers' claim data feeds. | |
| v | Describe your process for working with pharmacy benefit manager claim data feeds. | |
| v | Describe how your debit card features can be customized for different plan designs and spending accounts. | |
| v | Does your organization have the technology to view information online (i.e. account history, balance, etc.)? | |
| v | How do you verify card transactions? | |
| v | How do participants request a debit card? | |
| v | What is the maximum number of debit cards per account holder? |
&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P
Template Flexible Spending Account Questionnaire Comparison
| Organization | Carrier 1 | Carrier 2 | ||
| v | Identify and describe your relevant experience with administering FSA services similar to this plan in both size and design. | |||
| v | Provide three current client references similar in size (based on funded lives) and industry. Include contact name, title and phone number. | |||
| v | Provide three prior client references similar in size (based on funded lives) and industry. Include contact name, title, and phone number. | |||
| Implementation | ||||
| v | Describe your process for implementation of the benefit plan including: | |||
| v | Timeline required by your company. | |||
| v | ID card design and welcome package options including time needed for approval by City of Burleson . | |||
| v | Claim form design and approval from City of Burleson . | |||
| v | Participant material production, review, approval, and distribution process. | |||
| v | Implementation and open enrollment communication strategy. | |||
| v | Assuming a business award date of (date), please include a copy of your detailed transition plan/timeline that includes completion dates for each specific task. List any start-up fees. | |||
| v | Please provide an implementation guarantee that includes having ID cards in employees hands and loading/testing of all benefits accurately on or before the effective date of the new plan. Include 'drop dead' dates for receiving all information and the fees you will place at risk for non-performance. |
| v | What type of cost and performance guarantees are you willing to provide for the following areas, along with the amount you will be putting at risk: | |
| v | Implementation | |
| v | Delivery of Cards | |
| v | Delivery of Contract/SPD | |
| v | Account Management | |
| v | Claims Processing | |
| v | Customer Service | |
| v | Reporting | |
| v | Are your fees (rates) guaranteed for more than one year? If not, are you willing to provide a guarantee of two or three years? | |
| v | Do you provide introductory letters to member homes? | |
| v | If so, please provide a copy of your standard new member communications materials. | |
| v | Are you willing to work with the incumbent vendor to transfer data electronically through out the implementation phase? | |
| v | Open enrollment meetings each year will be held at each of the [Client]'s facilities . The carrier representative will need to be available to attend those meetings. There could be as many as ___ different enrollment meetings the first year of implementation. | |
| v | Are you willing to set up and host a "Net Meeting" or a "Web Cast" in order to accommodate open enrollment for employees who live in more rural areas or areas with few employees? | |
| v | Please provide if you will allow enrolled members to change or drop coverage during an annual open enrollment period. | |
| v | What is the minimum amount of time you believe is necessary to implement City of Burleson 's plans in an efficient and effective manner? | |
| v | Do you offer an integrated program (one system, one member, service number, etc.)? | |
| v | Will you require City of Burleson 's members/employees to complete new enrollment forms? | |
| v | What specific information, not already provided in this RFP, do you need in order to be able to implement properly? | |
| Communication | ||
| v | Do you provide the following at no additional cost? | |
| v | Enrollment kits, posters, brochures | |
| v | Monthly employee articles | |
| v | Monthly payroll stuffers | |
| v | Wallet cards | |
| v | Ongoing employee orientations | |
| v | Participate in health fairs and/or organizational events | |
| v | Monthly HR e-mailer | |
| v | Member access to a Web site for educational tools | |
| v | Can your Web site be customized by client? | |
| Customer Service/Member Service | ||
| v | Describe your standards and procedures for maintaining contact with the employer and employee. Provide timing of these contacts. | |
| v | Does your organization have service offices in [City/State]? If not, from which location will you service City of Burleson 's account? | |
| v | Do these offices have previous experience in City of Burleson 's type of business? If yes, please specify which and what size employee groups. If not, what will you do to become familiar with the claims experience and nuances of City of Burleson 's business? | |
| v | Will you guarantee that all incoming calls form City of Burleson will be returned the same day they are placed? | |
| v | Do you provide dedicated customer service teams to handle member questions/issues or do service center call agents handle claim issues? | |
| v | The bidder will provide a description of their resources for effective and timely customer service. This will include current customer service staffing levels, dedicated staff commitments, customer service representative (CSR) training (initial and ongoing), systems for CSR call reporting and tracking, CSR performance management and other related activities. | |
| v | Specify the documentation procedures for inquiries to the customer service department. | |
| v | What percentage of inquiries are documented? | |
| v | Are inquiries updated immediately? | |
| v | Please answer the following regarding your customer service reporting capabilities. | |
| v | Will you provide client-specific reports? | |
| v | Will you provide issue-specific reports? | |
| v | How frequently will customer service reports be provided to City of Burleson ? | |
| v | Does your company have employer online eligibility capabilities? | |
| v | Does your company have employee online eligibility capabilities? | |
| Account Management | ||
| v | What is the current number of clients serviced by the account manager/account executive that would be assigned to City of Burleson ? | |
| v | Do you provide a dedicated account manager? | |
| v | What was the turnover rates of your account managers for the last three years, respectively? | |
| v | Will you provide support to City of Burleson to manage client eligibility and other administrative tasks? Can City of Burleson update in real time on-line? | |
| v | How will you help City of Burleson monitor plan performance? | |
| v | How frequently do you provide status updates to your clients? What information is documented and provided at these meeting? | |
| v | How often will your account manager review the quality and effectiveness of the program with the client? | |
| Claims | ||
| v | Please provide the location(s) where [client] claims would be paid. | |
| v | How long have you been processing claims in this location(s)? | |
| v | How many employees are located in this claims office(s)? | |
| v | In this claims office(s), how many covered employees do you process claims for? | |
| v | In this claims office(s), specify the number of accounts you process claims for by employee. | |
| v | In this claims office(s), how many covered employees are included in the largest account for which your serve as claims administrator? | |
| v | In this claims office(s), what is the average size account? | |
| v | Will you allow City of Burleson to choose an auditing firm, to perform an operational and claims audit, without incurring cost from you? | |
| v | Do you have the capability to feed the client's Flexible Spending Account (FSA) vendor claims data to be used for substantiation of claims under the FSA program? | |
| v | Is it available for this client? | |
| v | If so, is there an additional cost for this service? | |
| v | What claims reporting will be provided to monitor claims dollars paid in-network, dollars paid by participant tier, total savings attributable to network discounts, dollars not covered, etc? Provide samples of claims reports considered ‘Standard’ and those considered ‘Custom’ (additional cost). |
| v | Is claim verification required (copies of receipts)? Please clarify for groups with and without Debit Card availability. | |
| v | Is a Debit Card an option or is it mandatory? | |
| v | Is there a charge for an additional debit card? | |
| v | Does the Debit Card have "excluded facility" function (i.e., at the pharmacy)? | |
| Financial Information | ||
| v | What is your minimum participation requirement, if any? | |
| v | What are standard commissions? | |
| v | Please describe the banking options for bill payment that are available to this client. | |
| v | Please provide a detailed list of the standard exclusions and limitations included within your standard contract. | |
| v | Have you waived the actively at work/non-confinement clause? Please explain. | |
| v | Have you waived all limitations for preexisting conditions, subject to plan provisions (no loss-no gain)? | |
| v | Please provide your limitations/language regarding experimental/investigational procedures. | |
| v | Please list your typical set-up fees (if any): | |
| v | Is this rate flexible or is it a set rate depending on client size, bundling products, etc? | |
| v | Do these ongoing fees vary by client size? | |
| v | Administration (per HCRA participant per month) | |
| v | Administration (per DCRA participant per month) | |
| v | Minimum monthly fee | |
| v | Renewal/annual fee | |
| v | Do you offer the optional services below? If yes, please indicate applicable fees/rates. | |
| v | Enrollment Kits | |
| v | Enrollment Meetings | |
| v | IVR/Web Enrollment with Spanish Capability | |
| v | Participant Confirmation Statements | |
| v | Section 125 Plan Document | |
| v | Summary Plan Description | |
| v | Direct Deposit Reimbursement | |
| v | Discrimination Testing for Highly Comp'd EE's | |
| v | Annual 5500 Form Preparation | |
| v | Is your administration fee inclusive of certain services or is "a la carte" pricing available? | |
| v | Are there any other services not listed above that are included in the Admin Fee? | |
| v | Do your costs vary by size of the client? If yes, please explain. | |
| v | If you assume run out on a grace period for a prior plan year, is there a monthly fee? | |
| Benefit Plan Design | ||
| v | What incentive-based benefit plan designs and communication tools do you have to encourage semi-annual preventive care and ongoing excellent health? |
v Describe how recent improvements in your administrative systems and billing capabilities will enhance the internal administration at City of Burleson .
| v | What plan designs can you support? |
| v | What resources will you provide to ensure effective and timely communication of the new program? |
| v | Do you have the ability to price only desired services (i.e., a la carte) versus your full array of services? | |
| v | Please describe your willingness to waive pre-existing condition limitations? | |
| v | Do you offer limited reimbursement accounts? | |
| Reporting | ||
| v | Describe what reporting is available to City of Burleson . | |
| v | Can City of Burleson generate these reports? Is this reporting capability available on-line at no additional charge? | |
| v | Do you offer ad hoc or special-request reporting? Are these also available on-line? Are there additional fees for the standard reporting package and/or ad hoc reports? If so, explain costs. | |
| v | What standard reports are available and how frequently (monthly, quarterly, annually)? Are there additional costs associated with any of these reports? | |
| v | Does your reporting indicate the following: | |
| v | Total Identified Members | |
| v | Total Participating Members | |
| v | Total Members who declined participation | |
| v | Are customized reports available through your organization's web site? | |
| v | Do you provide the client reporting on the number of face-to-face consultations? | |
| Underwriting and Renewal | ||
| v | Do you agree to provide the renewal no later than 120 days prior to the renewal date? |
&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P
Back Cover
| Our Mission |
| To be the worldwide value and service leader in insurance brokerage, employee benefits, and risk management |
| Our Goal |
| To be the best place to do business and to work |
www.lockton.com
© 201 Lockton, Inc. All rights reserved.
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